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-�° A City of Decatur, Illinois r RETURN WITH BID <br /> ' #1 Gary K. Anderson Plaza <br /> -TA <br /> Decatur, IL 62523-1196 <br /> -- Minority Business Enterprise (MBE) <br /> Utilization Statement <br /> Date: '� ' Project Title: cc. � '. �t'4 .:4lel' �/ ITS 1_6(c:+4,4 <br /> Total Contract Value: " be GGi) . co Project Number. (;.% -c I <br /> Section I: Prime Contractor Information rr <br /> Prime Contractor: jj i;4- 3[u5 1 r'ee Cert vtv)va I LLL <br /> Address: f''`f i J M' /VcitIA <br /> 1cc,rttr>jfu�i� IL 61705 <br /> Phone: (34 *2-412-7 <br /> Contact Person: Fr /AO Nil! <br /> l! <br /> Email: br'Iaptc't:<Kbro;iree5.LvAA <br /> Section II: Selected Subcontractors <br /> Subcontractor Name MBE or Amount %of Total Scope of Work <br /> Non-MBE Contract <br /> Totals <br /> • If more subcontractors are utilized,please copy this form and attach the additional information. <br /> Section III: Purchase of Goods,Materials,or Equipment <br /> Minority Business Enterprise Name Amount %of Total Scope of Work <br /> Contract <br /> Totals <br /> • If more firms were contacted,please copy this form and attach the additional information. <br /> Rev 08/2020 <br />